Tracie Lee Kelly, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

22948 Issued in CA

Practice address

517 N Main St
Santa Ana, CA 92701-4686

Phone

(714) 647-0401

NPI assigned

Nov 2, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Latino Health Services Medical Group Inc

  • Primary Care Clinic/Center
  • Santa Ana, CA
  • NPI 1790701514
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383350400000",
    "number": "1942639760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 N MAIN ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927014686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 N MAIN ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927014686",
            "telephone_number": "714-647-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TRACIE",
        "middle_name": "LEE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-02",
        "last_updated": "2013-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "793605",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "22948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Keith, BT
• Christopher Lee Keller
• Cynthia Keller
• Anthony Kelly
• Ronald C Kelly, D.C., Q.M.E.
• Kelvin Mai, D.O., Inc
• Kem Health Group Corp
• Hammam Ghiyas Kemeh, M.D.
• Elisa Kemmer, P.T.
• Benedict Kemper

• Nurse Practitioner in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.